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Bryan R. Anderson [1] and Jaron Marriott [1] and Chinthaka Bulathsinghala [1] and Humayun Anjum [1] and Salim Surani [1; 2]
Academic Editor: Stephen A. Klotz
1, Bay Area Medical Center, Corpus Christi, TX, USA, bamc.org
2, Texas A & M University, College Station, TX, USA, tamu.edu
Received Sep 11, 2017; Accepted Dec 3, 2017
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
1. Introduction
Gastrointestinal histoplasmosis is a well-described phenomenon, occurring almost exclusively in immunocompromised patients. An estimated 70–90% of patients with disseminated histoplasmosis have GI involvement. Of these, only 3–12% are believed to have GI-related symptoms [1]. The most commonly involved sites are the colon and distal ileum, with weight loss, abdominal pain, fever, and diarrhea being the most frequent symptoms. Several case reports and case series have described bowel obstruction and, rarely, perforation, the most common sites being colon or ileum [2–9]. Jejunal perforation has been reported only three times in our literature review [2, 10, 11]. We hereby present an HIV patient presenting with an acute abdomen found to have diffuse jejunal and mesenteric disease. Exploratory laparotomy revealed jejunal perforation.
2. Case
A 39-year-old HIV-positive male presented to the Emergency Department complaining of severe, sharp pain diffusely across the abdomen that had awoken him from sleep at 01 : 30 AM. He had been experiencing milder, intermittent abdominal pain for 2 months before. Additionally, he admitted to chills, weight loss, loss of appetite, nausea, and occasional diarrhea and vomiting for 1 month. There was no reported hemoptysis, hematochezia, melena, or fevers. He had a cough with green sputum for 2 months as well.
He had a past medical history significant for HIV due to IV drug use diagnosed 10 years earlier that he had neglected to treat. He has hepatitis C as well. He previously has abused alcohol but had quit 2 months ago, and quit IV drug use 11 years ago. He has less than 10 pack/year smoking. He has been in a monogamous relationship with his girlfriend for multiple years and denies any history of risky sexual behaviors including having polygamous or homozygous relationship. He has...